Bilingual Prior Authorization Specialist

Seeking a highly organized and articulate Virtual Prior Authorization Specialist to manage clinical administrative tasks, including obtaining prior authorizations, managing denials, and coordinating with insurance providers, clinical staff, and patients in a fast-paced medical practice.

Location: Remote (US)

Responsibilities

• End-to-End Authorization Management: Submit and secure prior authorizations for complex procedures, medications, imaging, and referrals.
• Clinical Review Coordination: Review clinical charts within ModMed/EMA to ensure documentation supports payer requirements.
• Proactive Payer Follow-Up: Manage authorization tracking and follow up with insurance teams.
• Appeals & Denials Processing: Research, write, and submit appeals for denied authorizations.
• Insurance Verification & Utilization Tracking: Conduct eligibility checks, verify coverage, track expiration dates, and manage renewal cycles.
• Patient Communication & Administrative Alignment: Communicate coverage updates to patients, partner with clinicians for clinical notes, and document all correspondence.

Requirements

• Minimum 2+ years of prior authorization and insurance appeals experience in a U.S. medical practice.
• High-level bilingual fluency in English and Spanish, with clear, articulate English communication.
• Operational understanding of CPT codes, ICD-10 codes, and medical necessity documentation rules.
• Willingness to work remotely with a secure, HIPAA-compliant home office setup.